Lillys Fine Lingerie, Inc.

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

LILLYS FINE LINGERIE, INC.

Doing business as

dba Lillys Mastectomy & Wig Boutique

Practice address

5 Station Plaza
Glen Head, NY 11545

Phone

(516) 674-8109

NPI assigned

Aug 4, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Diane M Bruscella, CMF

Title

Owner

Phone

(516) 674-8109

Specialties & licenses 1

Addresses

Other names 1

• dba Lillys Mastectomy & Wig Boutique Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332115200000",
    "number": "1083622740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 STATION PLAZA",
            "city": "GLEN HEAD",
            "state": "NY",
            "postal_code": "11545",
            "telephone_number": "516-674-8109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 STATION PLAZA",
            "city": "GLEN HEAD",
            "state": "NY",
            "postal_code": "11545",
            "telephone_number": "516-674-8109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LILLYS FINE LINGERIE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2012-03-19",
        "status": "A",
        "authorized_official_last_name": "BRUSCELLA",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-674-8109",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CMF"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "dba Lillys Mastectomy & Wig Boutique",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Margaret H. Lavi Deo, S.L.P.
• Lawrence J. Robinson, MD., P.C.
• Leland W. Petersen, Psychologist, P.C.
• Alyson Lewis-Anner, LCSW
• Jaclyn Liang, RPH
• Linda S. Lamarca, PH.D.
• Samantha Sasha Lindo, FNP
• Stewart Lipner, PHD
• Shira Leah Lippman, DDS
• Lisa a. Cavanaugh, M.D., P.C.

• Prosthetic/Orthotic Supplier in Glen Head, NY
• Providers in Glen Head, NY by specialty
• Prosthetic/Orthotic Supplier in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.